Revenue Cycle Management Operations Lead

New Department Development

Lead the establishment of revenue cycle operations for a newly launched market, including researching payer requirements, workflows, billing processes, and reimbursement guidelines.
Develop, document, and implement SOPs, workflows, and operational best practices to support future team growth.
Research and interpret Georgia and New Jersey Medicaid billing requirements and identify operational requirements necessary to support compliance and reimbursement.
Partner with leadership to define team structure, operational processes, performance metrics, and future KPIs as the department scales.
Identify process gaps and recommend solutions to improve operational efficiency and future revenue cycle performance.

Team Leadership

Initially operate as an individual contributor while building the foundation of the department.
Transition into a people leadership role as the Georgia and New Jersey markets expand, including hiring, training, coaching, and managing billing team members.
Provide mentorship, onboarding support, and performance coaching to future team members.
Experience conducting performance reviews is highly preferred.

Billing Operations

Oversee the preparation, submission, and follow-up of insurance claims for home health care services.
Ensure accurate coding (CPT, HCPCS, ICD-10) and adherence to payer-specific guidelines.
Monitor and resolve claim rejections, denials, and underpayments promptly.
Manage accounts receivable to minimize outstanding balances and maximize collections.

Compliance and Documentation

Ensure billing practices comply with federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.
Maintain up-to-date knowledge of changes in billing rules and home health care regulations.
Review documentation for accuracy and completeness to support submitted claims.

Process Improvement

Analyze billing processes and implement strategies to improve efficiency and reduce errors.
Collaborate with other departments to address issues impacting the revenue cycle, such as intake and documentation workflows.